Pelvic Fracture

Pelvic Fracture

What is it?
Pelvis is a ring bone at hip level. Pelvic fracture is break in any of the bones making the ring is. When forceful injury causes a fracture in one part of the structure, there is often a matching fracture at the opposite point in the ring

Cause
Break in the ring of the pelvis can result following:
• Simple falls or trips when the bones are ‘thin’ (osteoporosis) in the elderly; or
• Forceful injury as in case of a car crush or fall from a height.
Symptoms
Symptoms of pelvic fracture vary with the severity. However, it is almost always painful.
• Pain and tenderness in groin, hip, lower back, buttock or pelvis
• Bruising and swelling over the pelvic bones.
• Pain which may also be present on sitting and when having a bowel movement.
• Loss of sensation in the genitals and lower part of the body
• In severe injuries, it will not be possible to move the legs or walk around.
• Bleeding that is obviously seen or conceled inside the body cavity resulting in shock.
Diagnosis
All forceful injuries must routinely be x-rayed as part of initial trauma patient assessment.
X-ray shows most of the bony injuries, but needs to be taken with various views from different angles.
A computerized tomography (CT) scan is an important imaging modality as the pelvis is a complex structure to see the details of the fracture and if there is associated organ damage. It will also enable us to see three-dimensional (3D) reconstruction of the injuries.
At times when the need arises ultrasound scans and a magnetic resonance image (MRI) might be needed.
If we see underlying ‘thinning’ of your bones, we will also request dual-energy X-ray absorptiometry (DXA) to check your bone density.
Blood tests to assess the degree of blood loss and the function of the liver and kidneys, and testing of the urine to look for damage to the urinary tract system.

Treatment
Factors determining the treatment need in pelvic ring injury are:

  • stability of the pelvic ring (Stable Vs. Unstable fracture);
  • bleeding and medical stability of the patient;
  • location of the fractures; and
  • presence of associated injuries.
    Emergency life saving interventions
    Pelvic injury is a life-threatening trauma when it is unstable as it can be associated with excessive uncontrollable bleeding. Hence, timely arrival to appropriate facility is key.
    When a patient has an unstable pelvis and is in shock due to bleeding, the main aim of our treatment focus is to save the life.
    The primary focus of treatment is to stabilize the pelvis and prevent further blood loss, while at the same time replacing the lost blood.

After managing the life-threatening condition, we then focus on how to best hold the bones still to allow healing.
Non surgical treatment
Some fractures are stable enough and can be treated without surgery. These include
Stable fractures

Fractures that need surgery include:
Surgical treatment
Dr Sami has extensive experience in management of these life-threatening and complex injuries in Ethiopia. He was the first fellowship trained sub-specialist in the field and has adopted the knowledge and skill he acquired abroad to manage these injuries in country. His contribution in Ethiopia was recognized with a “Merit Award” by the Ethiopian Society of Orthopaedic and Traumatology, March 2017. He teaches these skills for both Ethiopian and African orthopedic surgeons in Ethiopia. He further travels abroad to share his experience with the international community in the field.

One of such local adoption of surgical intervention in resource limited setting like Black Lion (Tikur Anbessa) hospital is shown in this video.

Compiled and written on June, 2021. By Dr. Samuel Hailu.

*Disclaimer:*The information contained herein is for educational purposes only. This should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your healthcare provider because of any information you read on this topic.